What do MoveOn members think about health care?

Here are the polls we sent to random samples of MoveOn members (our typical approach when we have a decision to make) and the results. The polls lay out each side's strongest case.

Strategy poll (with names of supporters):

There's massive public support for universal health care, and Barack Obama has promised to make it a top priority if he's president.

Many, though not all, progressives agree that the best way to guarantee universal health care is a "single payer" national health care system.

But progressives disagree about how to get there. Here are both sides of the argument. What do you think?

A single payer health care system would be like Medicare for all—all Americans would be covered, patients could choose their own doctors, and private insurance companies wouldn't be involved.

Some folks like Dennis Kucinich, John Conyers, and Michael Moore—as well as groups like Physicians for a National Health Care Plan and the California Nurses Association (the largest nurses union in the country)—think we should only support single payer health care proposals. They say private insurance companies are driving prices up and quality down because they exist to make profits, not guarantee good health care. Therefore, we should eliminate private insurance from our health care system. This, they argue, will garner enough cost savings to pay for quality health care for everyone. Only a single payer system will abolish private health insurance companies.

But others like Obama, Hillary Clinton, and John and Elizabeth Edwards—as well as groups like Planned Parenthood, TrueMajority, and SEIU (the largest health care union in the country)—favor a different approach. They point to the fact that, because single payer would force people to trade their existing health insurance for the national system, it's been very easy for our opposition to defeat single payer proposals. Polling shows people get very nervous about being forced to switch. In general, these folks favor a different strategy: we should push first to establish a national health care system like Medicare for everyone who wants, to prove how well single payer works.

That means there'd be universal health care coverage—but people can keep their existing insurance plan if they want to. Once people see the national health care system works, experts believe most people will choose to switch.

Our goal is to pass universal health care next year. Which strategy do you think makes sense?

Support single payer: Work to cover all Americans by switching everyone from their existing health coverage to free Medicare-style national health insurance and abolishing private insurance companies from our health care system.(23%)

Support the Obama/Clinton/Edwards plan: Work to cover all Americans by offering everyone the choice to switch from their existing health coverage to free or affordable Medicare-style national health insurance, but don't require people to switch.(70%)

Support something else:(7%)

Why do you think this is the best strategy to pass universal health care?

Strategy poll (without names of supporters):

There's massive public support for universal health care, and Barack Obama has promised to make it a top priority if he's president.

Many, though not all, progressives agree that the best way to guarantee universal health care is a "single payer" national health care system.

But progressives disagree about how to get there. Here are both sides of the argument. What do you think?

A single payer health care system would be like Medicare for all—all Americans would be covered, patients could choose their own doctors, and private insurance companies wouldn't be involved.

Some progressives think we should only support single payer health care proposals. They say private insurance companies are driving prices up and quality down because they exist to make profits, not guarantee good health care. Therefore, we should eliminate private insurance from our health care system. This will garner enough cost savings to pay for quality health care for everyone. Only a single payer system will abolish private health insurance companies.

But other progressive health care advocates point to the fact that, because single payer would force people to trade their existing health insurance for the national system, it's been very easy for our opposition to defeat single payer proposals. Polling shows people get very nervous about being forced to switch. In general, these folks favor a different strategy: We should push first to establish a national health care system like Medicare for everyone who wants, to prove how well single payer works.

That means there'd be universal health care coverage—but people can keep their existing insurance plan if they want to. Once people see the national health care system works, experts believe most people will choose to switch.

Our goal is to pass universal health care next year. Which strategy do you think makes sense?

Support single payer: Work to cover all Americans by switching everyone from their existing health coverage to free Medicare-style national health insurance and abolishing private insurance companies from our health care system. (26%)

Support national public health insurance: Work to cover all Americans by offering everyone the choice to switch from their existing health coverage to free or affordable Medicare-style national health insurance, but don't require people to switch. (64%)

Support something else: (10%)

Why do you think this is the best strategy to pass universal health care?

Blog posts:

There's massive public support for universal health care, and Barack Obama has promised to make it a top priority if he's president.

Many, though not all, progressives agree that the best way to guarantee universal health care is a "single payer" national health care system. But progressives disagree about how to get there.

Read the arguments for both sides of this important debate below, then share your opinion. Which strategy do you think makes sense?

A Case for Supporting a National Public Health Care Plan Like Medicare

This is part of a blog post by Richard Kirsch, the director of Health Care for America Now, a large new progressive coalition that's working to pass a universal health care plan similar to that proposed by Obama, Clinton, and Edwards.

I was a leader of the fight for single-payer reform during from 1988 to 1994. I co-wrote with Richard Gottfried -- then and now the Chair of the Health Committee of the New York State Assembly -- the only fully-financed single-payer bill to ever pass a state legislative body in the country... I wrote a training manual and talking points for candidates for Congress to use in running on single-payer in 1992. I could go on, but you get the idea.

So what happened to me? Five years ago, I sat down to write a history of the struggle to win a single-payer system. Here's what I wrote in the preamble to that article:

I intended to write this piece as a cautionary tale for both the new generation of organizers for universal health care and the veterans of the last fight. To my surprise, the writing led me to a fresh understanding of the paradox of achieving universal health care in the United States: the political debate about health care reform is turned upside down once the debate turns from the problem state to the solution stage. At that point, people become more scared about what they will lose from reform than what they will gain. This conclusion led me to reframe my view of how we go about organizing for universal health care, and -- to my even bigger surprise -- to outlining a new proposal for comprehensive reform.

I wrote at the time: "So here's my proposal, in a nutshell: provide everyone in the country with the option, and the means of paying for, coverage through Medicare or through private insurance."

One point of this approach was not to scare people away from reform or to make it easier for the opponents of reform to panic the public. I realized we could reassure people about change by building on what people are familiar with -- both private insurance and Medicare's public insurance plan.

A lot of what I wrote at the time also had to do with the need to reaffirm the positive role of government in America. To do that, we need to demonstrate that government can better people's lives in real ways. Even though it might make us feel good, stating our ideological position in the hope that people will eventually come around is not effective. We need to win real changes that show government can work in positive ways.

Our goal is to have the United States provide a guarantee of good, affordable health coverage to all its residents. That's the bottom line. A national health insurance plan (single-payer) is one way to accomplish the goal, but it's not the only way. In fact, one of the myths about health care around the world is that "everyone but us has single-payer." In fact, single-payer is the way Canadians provide a government guarantee of good health coverage. Other countries -- including the European countries usually held up as models -- do it differently, with all sorts of variations of public, private, and non-profit insurance and socialized medicine. But what's true in all these countries is that health care is guaranteed and regulated as a public good.

We need to keep our eye on the prize and on the real debate. It would be great -- a progressive dream -- if the political debate were between putting everyone into a government health insurance plan (single-payer) and having a very large public insurance plan along with regulated private insurance (which is what the HCAN principles say). But the real debate is between those of us who believe that health care is a public good where government has to guarantee quality, affordable coverage and those who think that the problem with the health care system is that the market's not working, and if we gave people a voucher to buy unregulated private insurance, it would solve everything.

We have to start where the American public is today. After seven years of the George W. Bush administration and 30 years of conservative dominance the American public is fearful about their economic status. Most Americans see the government as being corrupt, ineffective and on the side of wealthy special interests. People do not trust the government and that do not think that the government is on their side. Health care reform contains the promise to turn this around, to demonstrate that government can work for all of us, which the public interest can trump corporate interests and the "you are on your own" ethos of the new gilded age. Health care reform holds the promise to create a generation of Americans that support a government that works for everyone, just as the New Deal's advances led to four decades of activist government for the public good.

Coming off more than a quarter century of conservative domination of American politics, I am reminded that Karl Rove's hero, William McKinley, was followed by Theodore Roosevelt and the Progressive Era. Our job is to build a movement for health care reform that ignites the hopes and aspirations of the American people, the American values of opportunity and fairness. Winning real health care reform will requires a clear vision, a persistent, strategic energy and a belief in the miracle of change.

This is part of a blog post by Rose Ann DeMoro, the head of the California Nurses Association and National Nurses Organizing Committee, critiquing the new Health Care for America Now coalition described above (referred to here as HFCAN) and laying out the case for only supporting a single payer plan.

The big splash of news and internet coverage for the new Health Care for America Now coalition of labor, progressive and liberal groups is a reminder of the critical importance of health care reform. And a reminder that partial solutions, such as those proposed by the coalition, will only perpetuate, not end the health care crisis.

The groups behind the new coalition are working in concert with the Obama campaign and Democratic leaders in Congress to build "consensus" around a plan that would presumably be introduced in the first days of the next administration, and pushed through to a quick vote before opponents can mount a "Harry and Louse"-style counter attack.

But, in search of a supposedly politically viable plan, the advocates of this approach have surrendered in advance on the only overhaul that will actually cure the disease, a single-payer, expanded and improved Medicare for all reform.

Their good intentions will leave the same failed system in place, and will not even blunt the political opposition from those on the right and corporate interests who will continue to challenge anything that looks like even modest reform.

They create a false hope of systemic change that won't be, squandering the opportunity to achieve the fundamental reform so desperately needed with so many lives in the balance.

They've also missed one of the most important lessons of the failure of the Clinton plan of 1993-94 which collapsed in part due to the absence of a broad, grassroots, activist movement needed to counter the insurance industry. Only single payer engenders such a movement, the very reason the single payer bill now in Congress, HR 676, has more co-sponsors than any other reform bill with tens of thousands around the country already working to enact it.

Health Care for America Now has identified the main culprit and obstacle to genuine reform. As their inaugural ad proclaims, "Will health insurance companies ever put your health ahead of their profits? We can't trust insurance companies to fix the health care mess."

There's just one problem -- the coalition's proposal does nothing to end the actual practice of insurance companies putting their profits ahead of your health. Nor does it fix the two central components of the health care morass -- insurance company denials of care and the financial squeeze facing American families due to ever skyrocketing health care costs which is exacerbated by the escalating credit crisis.

Consider the four health care questions posed by families in [the coalition's] first 30-second ad: "Will they pay for his inhaler? Is my surgery covered? Can I choose my child's doctor? Will they cover the chemo?"

All are the direct result of care denials and price gouging by the insurers -- and none would be solved by the HCFAN "statement of common purpose."

How does the HCFAN coalition propose to crack down on the insurance pirates? With a "watchdog role" on the plans "to assure that risk is fairly spread" and that "insurers do not turn people away, raise rates or drop coverage based on a person's health history or wrongly delay or deny care."

You can watch someone rob your bank, but unless you stop them, the vaults are still going to be stripped bare. If you're looking for the hammer or any enforcement mechanism in the HCFAN proposal, don't bother, it's not there.

The insurers don't care if we know they are thieves, they will continue to deny and delay care because it's in their DNA. It's how they are set up to operate, it's how they make money for their shareholders, it's how they generate plush pay packages for their executives, and it's how they compete with the other insurance giants.

Nor does the HCFAN proposal contain any effective cost controls on the insurers. Their commitment to basing pricing on "ability to pay" is a recipe for merely getting the healthcare you can afford, not what you need. It also fails to assure real choice of providers beyond the limited network established by all private insurance plans.

The bone the coalition sponsors throw to single payer advocates is the false promise of a public plan side by side with private insurance. The public plan, they contend, will be so much more attractive that the private plans will just wither away. Don't count on it.

The insurance companies will always be able to lower their prices with cut rate plans with lower standards that they can aggressively market through massive advertising, tele-marketing, even door to door salesmen (as some do now) with a marketing campaign that the public plans will not have the funding to be able to match.

The private plans can then continue to cherry pick the younger and healthier patients while the sicker and older patients are dumped in the public plan, wrecking the whole idea of a risk pool and driving up the costs for the public plan to operate. The competition won't starve the private plans and cause them to wither away, they'll starve the public plan.
There's only one way to stop the insurance industry abuses -- it's to actually stop them. The rest of the world has figured this one out -- see the study in Britain earlier this year that found that the U.S. ranks last in preventable deaths among 19 industrialized nations even though we spend twice as much on health care as anyone else. Isn't it time we figured it out here as well?

Our goal is to pass universal health care next year. Which strategy do you think makes sense?

Support single payer: Work to cover all Americans by switching everyone from their existing health coverage to free Medicare-style national health insurance and abolishing private insurance companies from our health care system.
(42%)

Support the Obama/Clinton/Edwards plan: Work to cover all Americans by offering everyone the choice to switch from their existing health coverage to free or affordable Medicare-style national health insurance, but don't require people to switch.
(51%)

Support something else:
(7%)

Why do you think this is the best strategy to pass universal health care?

Paid for by MoveOn.org Political Action, http://pol.moveon.org/. Not authorized by any candidate or candidate's committee.

MoveOn.org Civic Action is a 501(c)(4) organization which primarily focuses on nonpartisan education and advocacy on important national issues. MoveOn.org Political Action is a federal political committee which primarily helps members elect candidates who reflect our values through a variety of activities aimed at influencing the outcome of the next election. MoveOn.org Political Action and MoveOn.org Civic Action are separate organizations.